The Federal Office of Rural Health Policy announced that for the 2016 Marketplace insurance plan year, the Centers for Medicare & Medicaid Services have released a draft of Essential Community Providers (ECPs) and many Rural Health Clinics (RHCs) are included on the list for the first time.
From the announcement:
ECPs are providers who care for predominantly low-income, medically underserved individuals. Under the Affordable Care Act, insurers (called Qualified Health Plan issuers) must include a minimum number of ECPs within their provider networks for plans sold on the insurance Marketplaces. Insurers can use the list to select ECPs to include in their provider networks. The draft list of ECPs and a description of the list are available here. Scroll down to the section titled “Other QHP Application Resources.”
An RHC is included on the list if it meets the following requirements:
1) Based on attestation, it accepts patients regardless of ability to pay and offers a sliding fee schedule, or it is located in a primary care Health Professional Shortage Area (geographic, population, or automatic); and
2) It accepts patients regardless of coverage source (i.e., Medicare, Medicaid, CHIP, Marketplace plan, etc.).
More than 3,300 RHCs currently meet these requirements and are included on the 2016 list. Any RHC not on the list is eligible to be added to a future version of the list by completing a form (the one used for automatic HPSA designation) available here and faxing it to HRSA, along with a copy of the clinic’s sliding fee schedule. Please note that the fax number provided on the form is incorrect; use 301-443- 2111 or 301-443-0463 instead. More info about the RHC auto HPSA designation process is available here.